This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetic foot ulceration is a multi-faceted problem involving the response of plantar soft tissue to both external forces (pressure and frictional forces) applied to the epidermis and internal changes (e.g., vascular supply, neuropathy) of the foot. This research project will combine state-of-the-art techniques for magnetic resonance imaging (MRI) quantification, plantar pressure measurement, and detailed finite element modeling (FEM) to examine the course of diabetes related changes in the plantar soft tissues. The MRI will be used to delineate soft tissues as well as the bones in the forefoot of diabetic patients who have experienced a foot ulcer in the past. This structural information as well as the plantar pressure measurements will be used to generate detailed patient-specific FEM of transverse sections of the forefoot to predict internal tissue stresses. These predictions will be compared with the occurrence of ulcers in the patient cohort evaluated over a period of one year. In addition to the structural and pressure changes of the foot, the subjects are evaluated in terms of the sensory ability of their foot in order to assess their risk of neuropathy. Viability of microcirculation and adequate blood flow to their foot is examined by measuring transcutanous oxygen tension to rule out peripheral vascular disease. Measurement of fluorescence from their feet is also used to assess alterations in their skin with diabetes. The data will be examined to identify the initial steps resulting in ulcer formation as they relate to stresses experienced by various plantar soft tissues such as skin layers and heel fat pad. With knowledge of the interactions between mechanical stresses and pathological tissue changes, the etiology of diabetic foot ulceration will be better understood.
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